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June 25, 2009

Real life evidence — government funded healthcare

Yesterday’s news provided updates on two healthcare stories we’ve been following, so here’s a quick update.

The Massachusetts Experiment

Readers will remember when Massachusetts signed the nation’s first state universal health insurance program into law. This program was to be the test ground to see how universal health coverage by the government would work here in the United States. “This is the healthcare plan seen by many as a model that could be replicated around the country,” the Boston Globe noted yesterday.

As is known, it made the purchase of state-approved health insurance mandatory for every resident, but within weeks of the law’s deadline for people to have purchased insurance, the state was scrambling. It hadn’t accurately budgeted for the program, and without enough doctors, 95% of doctors weren’t accepting more patients. Rationing of services, reductions in benefits and growing waits for care began. In efforts to keep the program solvent, Massachusetts cut payments to doctors and hospitals, reduced choices and benefits for patients, and was looking at increasing out of pocket expenses for patients.

By February of last year, the state was asking the Federal government and America’s taxpayers to bail it out and cover half of the program’s costs from 2009 through 2011. According to the Boston Globe, the program will cost taxpayers $1.35 billion annually by June 2011.

Yesterday, according to the Boston Globe, the near bankrupt Massachusetts healthcare program cut $115 million — 12 percent of its budget — from Commonwealth Care, which subsidies premiums for the poorest residents. The savings is planned to come from eliminating dental coverage for them; reducing enrollment of poor residents by no longer automatically enrolling those who forget to designate a health plan; and the bulk of the remaining “savings,” $32 million, will come from slowing payments to the managed-care health insurance companies with the plan. The board of the Connector Authority also dropped coverage for 28,000 legal immigrants beginning July 1st.

“There’s no other place to go for money,” Lindsey Tucker, the organization’s healthcare reform manager, told the Globe. The Massachusetts Legislature just passed $1 billion in tax increases, in part trying to keep it afloat. State Treasurer Timothy P. Cahill came out strongly against the tax increases and proposed deep cuts in the state’s universal healthcare plan, calling it a luxury taxpayers can no longer afford, said the Boston Globe.

The plan had been sold to the public as helping to pay for itself by shifting more people into managed care. “We’re all still waiting for the savings,” Cahill said. “Universal healthcare was supposed to eventually save us money.” Instead, the Massachusetts Taxpayers Foundation, a business-funded group that had advocated for the healthcare law, has found that state spending on the healthcare plan has increased by about $88 million a year since it was implemented. Healthcare accounts for about a third of the state budget, although it is difficult to know precisely how much of that is attributed just to the state’s new healthplan.

“Nobody asked the tough questions. It was expensive, even in good times,” said Cahill. “In tough times, it just doesn’t seem doable… It’s a warning for the federal government as it looks to do something similar,” Cahill added.

The VA Example

The American Legion, which visits and inspects Veteran’s Administration health centers, reported that doctors at a facility in Pennsylvania gave 92 veterans incorrect radiation doses for treatment of prostate cancer, and that 53 veterans were possibly infected with hepatitis and HIV from unsterilized equipment at three VA health centers in Florida, Tennessee and Georgia.

At a hearing yesterday of the Senate Committee on Veterans Affairs, it was learned that staff from the Veteran’s Administration in Washington, DC, has been making unannounced visits to every VA health facility in the country and has found that fewer than half could provide any evidence of proper procedures and training for sterilizing of colonoscopy and endoscopy equipment, even after having received repeated alerts from the VA about the problem. The hearing revealed that improper sterilization had put more than 200 veterans at risk for HIV and hepatitis B infections after colonoscopies and other screening tests. As Associated Press reports, at the Senate hearing, it was learned that six patients have tested positive for HIV and 46 have tested positive for hepatitis after having colonoscopies or endoscopies.

More astounding, according to the Philadelphia Inquirer, soon after officials closed the prostate cancer program at the Philadelphia VA Medical Center for botching 92 out of 114 prostate cancer radiation treatments — in some cases causing grave injury by placing radioactive pellets in other organs and even giving too low of doses and/or unknown doses because they were “flying blind” because the equipment didn’t work — the medical center had been accredited by the Joint Commission, the main group that assures “quality” at our nation’s hospitals.

As we’ve covered, not only does the Veterans Administration offer insight into how well government-provided healthcare works in reality, the Veterans Administration has taken the lead on computerizing its entire medical record system throughout its 155 hospitals, 881 clinics, 135 nursing homes and 45 rehabilitation centers. It’s been held up as an example of the benefits possible with nationalized integrated health IT for reducing medical errors.

Continuing software glitches since August 2008 hadn’t been disclosed to the public until the Associated Press obtained internal documents under the Freedom of Information Act. These revealed that VA patients around the country have been being given the wrong doses of medications and exposed to medical errors due to electronic medical records, some of which might have been life-threatening.

As Fox News reported, veterans groups and lawmakers say that VA hospitals are underfunded and short staffed, leaving doctors overworked and largely unable to provide the best care, facilities and equipment are old and broken down, and the system is showing signs of an institutional breakdown. Joe Wilson, deputy director of the Veterans Affairs and Rehabilitation Commission for the American Legion, who testified before Congress, described disturbing problems.

This is how government-funded healthcare cares for our poorest citizens and those men and women who served our country. How well will it care for the rest of us?